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Left ventricular diastolic function in hypertensive patients with different geometric patterns of left ventricle
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Abstracts
structured interviews and physical examination. Results: The prevalence of LVH was 52%, significantly higher among women (60% versus 43% p = 0.0033). Systolic blood pressure (SBP) was higher in women with LVH, 154 ± 19 mm Hg, vs. 146± 19 mm Hg in women without LVH, (p < 0.01), and to either group of men, p < 0.0002. In a multivariable logistic regression analysis with gender, diagnosed hypertension, diabetes, and congestive heart failure (CHF) as independent variables, the odds ratio for LVH was doubled for female gender, increased for hypertension, and CHF. An interaction term, between gender and SBP level was significant p = 0.016. The point estimate for female gender was decreased, and hypertension diagnosis is no longer statistically related to LVH, while CHF retains its association. When SBP level is entered into the regression then gender, hypertension, and SBP level, lose significance, which is maintained only for the interaction term, p = 0.037, and CHF, p = 0.047, suggesting that the gender effect on LVH is mediated by the SBP in women. Women with LVH were 3 times more likely than women without LVH and 6.5 times more likely than men with LVH to believe that a BP of 160/100 mm Hg represents their BP goal (p < 0.05). Conclusions: This study demonstrates a high prevalence of LVH in very elderly community dwelling subjects, higher in women and related to SBP. The inadequate understanding of BP goals in this subgroup may contribute to it. doi:10.1016/j.ijcard.2009.09.254
HT000164 Effects of ouabain on hypoxia-induced ANP release in beating rabbit atria L. HONGa, D.Z. DINGb, Y. LANa, X. CUIa,c a Department of Physiology, School of Basic Medical sciences, Yanbian University, China b Cardiovascular Department, Yanbian University Hospital, China c Key Laboratory of Organism Functional Factors of the Changbai Mountain, Ministry of Education, Yanbian University, China Objective: To confirm the effects of hypoxia on the atrial ANP secretion and to determine the relationship between ouabain and hypoxia induced ANP release. Methods: Experiments were performed in a perfused beating rabbit atrial model and thirty New Zealand white rabbits were used. Hypoxic atrial model was produced by Nitrogen gas. While setting up the model, atria were perfused for 60 min and the control period (12 min as an experimental cycle) was followed by different series of experiments simultaneously atrial dynamics were monitored. ANP levels in the atrial perfusates were measured by radioimmunoassay. Results: ① Hypoxia significantly increased atrial ANP secretion and concomitantly decreased atrial pulse pressure and stroke volume compared with control period. ② Ouabain (6.0 μmol/L) as an inhibitor of Na+–K+/ATPase increased atrial ANP secretion significantly. While atrial pulse pressure and stroke volume showed an increased tendency at the beginning when infusing ouabain one cycle, but then a decrease significantly occurred upon two cycles of recovery. ③ With pretreatment of ouabian (6.0 μmol/L), hypoxia still increased atrial ANP, but ouabain obviously attenuated the effects of hypoxia-induced ANP secretion. ④ Atrial histochemistry results showed that ouabain (6.0 μmol/L) induced atrial interstitial edema only. However, hypoxia induced interstitial edema simultaneously with cellular edema in atrial tissue section with or without ouabain. ⑤ In the presence of KB-R7943 (10 μmol/L), an inhibitor of reversed Na+–Ca2+ exchanger, the atrial tissue section showed cellular edema only by ouabain. Conclusions: ① Hypoxia significantly increased atrial ANP secretion in rabbit isolated atrium; ② Ouabain as an inhibitor of Na+–K+/ATPase significantly augmented atrial ANP secretion but attenuated the effects of hypoxia-induced increases of ANP release; ③ Hypoxia regulated
myocytic ANP release was closely related to Na+–K+/ATPase inhibition and atrial stretching. doi:10.1016/j.ijcard.2009.09.255 HT000227 The predictive effects of serum non-high-density lipoprotein cholesterol on the incidence of cardiovascular disease: Results from CMCS followed-up 12 years JIE REN, JING LIU, MIAO WANG, DONG ZHAO The Capital Medical University attached Beijing Anzhen Hospital, Beijing Institute of Heart, Lung & Blood Vessel Diseases, China Objective: To evaluate the predictive effects of serum non-highdensity lipoprotein cholesterol (non-HDL-C) on risk of cardiovascular diseases (CVD) in Chinese population aged 35–64 years. Methods: This prospective study was performed from 1992 to 2004 in 11 provinces of China and the association between baseline non-HDL-C level and the risk of CVD was analyzed in 29,937 subjects aged 35– 64 years using Cox multivariate proportional hazards regression. CVD including acute coronary event (ACE), acute ischemic stroke, hemorrhagic stroke and total CVD events. Results: (1) Adjusted for age, sex, smoking status, diabetes, body index and blood pressure, the relative risk of ACE and CVD in groups of non-HDL-C 130–159, 160– 189 and ≥190 mg/dL was 1.24 (0.91–1.70), 1.78 (1.25–2.53), 2.23 (1.48–3.35) and 1.37 (1.16–1.62), 1.54 (1.26–1.88), 1.60 (1.25–2.04), respectively. Significantly higher than reference group (<130 mg/dL). The risk of ischemic and hemorrhagic strokes was higher in groups 130–159 and 160–189 mg/dL than reference group, RR was 1.34, 1.38 and 1.49, 1.69 respectively, but no difference was found in group≥190 mg/dL. (2) NonHDL-C was responsible to 12.9% of the ACE and 6.5% of the total CVD. (3) When VLDL-C and LDL-C were jointly analyzed, an increased incidence of CAE and CVD was found with the increase of VLDL-C, the relative risk in group of VLDL-C 20–30 mg/dL was the most obvious in all groups. No difference was found in ischemic and hemorrhagic strokes. Conclusion: Non-HDL-C was strongly associated with the incidence of ACE and CVD. VLDL-C plays a critical role in the development of ACE and CVD. The relationship between non-HDL-C and ischemic and hemorrhagic strokes was unclear in Chinese population. doi:10.1016/j.ijcard.2009.09.256 HT000245 Left ventricular diastolic function in hypertensive patients with different geometric patterns of left ventricle BRANISLAVA IVANOVIC, MARIJANA TADIC Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Yugoslavia Objective: The aim of this study was to evaluate diastolic function of left ventricle in hypertensive patients with different geometric patterns of left ventricle. Design and met:h:od: The study included 88 hypertensive patients (mean age 52 ± 8 years) and 45 healthy persons (mean age 51 ±7 years). The endsystolic and enddiastolic left ventricle dimensions, thickness of interventricular septum (IVS) and left ventricle posterior wall (PWT) were measured in all subjects by using two-dimensional echocardiography. The ratio of early and late diastolic transmitral flow velocities (E/A) was assessed by Doppler echocardiography and the ratio of early diastolic mitral flow velocity was achieved by pulsed-wave Doppler and tissue Doppler (E/Ea) in all subjects. Left ventricle mass index (LVMI) was calculated for all subjects. According to the value of relative wall thickness (RWT) and LVMI hypertensive patients were subdivided into four groups: normal (N) 30 (34%), concentric remodeling (CR) 28 (31.8%), concentric
Abstracts
hypertrophy (CH) 20 (22.7%) and eccentric hypertrophy (EH) 10 (11.4%) patients. Results: The E/A ratio gradually decreased in hypertensive patients from N to EH group (N, 1.1 ± 0.13; CR, 1.01 ± 0.14; CH, 0.88 ± 0.15; EH, 0.85 ± 0.14), and it was lower comparing it with control group (1.24 ± 0.19), (p < 0.01 for all). The E/Ea ratio was higher in all hypertensive groups (N, 9.43 ± 1.72; CR, 10.09 ± 2.86; CH, 14.85 ± 3.76; EH, 11.66 ± 3.03) compared with the controls (6.58 ± 1.12), (p < 0.01 for all). In CH group the E/Ea ratio was higher than in N, CR and EH groups (p < 0.01, p < 0.01, p = 0.02, respectively). The E/Ea ratio in hypertensive group was correlated with LVMI (r = 0.29, p < 0.01), RWT (r = 0.21, p = 0.032) and IVS (r = 0.31, p < 0.01). Conclusion: Left ventricular diastolic function is impaired in all hypertensive patients. The degree of geometric pattern diastolic cardiac function damage is the most obvious in concentric hypertrophy left ventricle geometric pattern. doi:10.1016/j.ijcard.2009.09.257 HT000246 The impact of different geometric patterns of left ventricle on myocardial performance index in hypertensive patients BRANISLAVA IVANOVIC, MARIJANA TADIC, DRAGAN SIMIC Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Yugoslavia Objective: The aim of this study was to evaluate global left ventricle function in hypertensive patients with different geometric patterns of left ventricle by using myocardial performance index (MPI). Design and method: The study included 88 hypertensive patients (mean age 52 ± 8 years) and 45 healthy persons (mean age 51 ± 7 years). The endsystolic and enddiastolic left ventricle dimensions, thickness of interventricular septum (IVS) and left ventricle posterior wall (PWT) were measured in all subjects by using two-dimensional echocardiography. The left ventricle mass index (LVMI) was calculated for all. The ratio of early and late diastolic transmitral flow velocities (E/A), the global left ventricular isovolumic relaxation (IVRT) and contraction time (IVCT), and ejection time (ET) were achieved by pulsed-wave Doppler. MPI was calculated by using the formula (IVRT + IVCT) / ET. According to the value of relative wall thickness (RWT) and LVMI hypertensive patients were subdivided into four groups: normal (N) 30(34%), concentric remodeling (CR) 28 (31.8%), concentric hypertrophy (CH) 20(22.7%) and eccentric hypertrophy (EH) 10(11.4%) patients. Results: The E/A ratio gradually decreased in hypertensive patients (N, 1.1 ±0.13; CR, 1.01 ± 0.14; CH, 0.88 ±0.15; EH, 0.85 ± 0.14), and it was lower comparing it with control group (1.24 ±0.19), (p < 0.01 for all). In all hypertensive groups of patients the MPI was higher than in controls (N, 0.54 ±0.05; CR, 0.57 ± 0.06; CH, 0.68± 0.08; EH, 0.58± 0.06 vs. 0.38 ±0.04; p < 0.01 for all hypertensive groups). The MPI was higher in CH group than in N, CR and EH group (p < 0.01 for all). The MPI of hypertensive patients was correlated with LVMI (r = 0.32, p < 0.01), RWT (r = 0.28, p = 0.02) and IVS (r =0.35, p <0.01). Conclusion: The global left ventricle function is impaired in all hypertensive patients according to MPI compared with controls. This damage is the most evident in concentric hypertrophy geometric pattern. doi:10.1016/j.ijcard.2009.09.258 HT000343 Five years prognosis of patients with arterial hypertension and left ventricular hypertrophy DRAGAN DJORDJEVICa, IVAN TASICa, BOJANA STAMENKOVICa, MILAN LOVICa, BRANKO LOVICb, DRAGAN LOVICb a Institute for Treatment and Rehabilitation Niska Banja, Yugoslavia b Inter Medica, Yugoslavia
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Objectives: Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiovascular complications independently of other known risk factors. In practice, it is very important to predict outcome for every patient at the beginning of the treatment. The aim of the study was to examine the correlation between non-invasive parameters at the beginning of the study and bad outcomes in patients with essential arterial hypertension and left ventricular hypertrophy after five years follow-up, using regular antihypertensive therapy. Design and methods: Ninety patients (average age 55 years) with essential hypertension and left ventricular hypertrophy were examined. All patients were studied at baseline, after discontinuation of previous antihypertensive therapy for at least four half-lives. The follow-up period, started at the baseline examination and lasted five years. Adverse cardiovascular events occurred in 15 (16.7%) patients. Results: Noninvasive parameters were tested by stepwise multiple regression analysis. Three examined parameters had predictive value: QTc interval dispersion (beta = .325, p = 0.001), septal wall thickness (beta= .294, p = .003) and low increase of heart rate during exercise testing (beta = −.202, p < .04). For this model adjusted R square = .203; F3,84 = 8.406, p < 0.0001. Conclusions: Patients with greater QTc dispersion, greater septum thickness and lower increase of heart rate during exercise testing have bad five years outcome in spite of regular medical treatment. These patients should be recognized as early as possible and treatment should be more aggressive. doi:10.1016/j.ijcard.2009.09.259
HT000396 Relationship between left atrial deformation and left ventricular diastolic dysfunction in hypertensive patients: A strain rate imaging study ZHIQIANG GUANa, DI ZHANGa, FANG ZHANGb, QINGRON WANGa, RONJIE HUANGc, SHANGYON ZHUa a Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, China b Department of Electrocardiography, The First Affiliated Hospital of Guangxi Medical University, China c Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, China Objectives: The present study was designed to investigate the relationship between left atrial (LA) myocardial function and left ventricular (LV) diastolic dysfunction by strain rate imaging. Design and methods: 48 essential hypertensive patients and 21 age-matched normal controls were included in the study. LV diastolic dysfunction was classified into no, mild, moderate, and severe groups by using conventional echocardiography and tissue Doppler imaging (TDI). Peak strain rate in the systole (S-Sr), early diastole (E-Sr) and late diastole (ASr) was obtained from Doppler derived strain rate imaging to evaluate the LA myocardial deformation. Association between LA myocardial deformation and ratio of mitral peak E velocity to mitral annulus early diastolic velocity (E/Em ratio) was assessed by Pearson correlation coefficient. Results: E-Sr was significantly lower in hypertensive patients than normal controls (0.88 ± 0.35 s− 1 vs 1.04 ± 0.18 s− 1, p = 0.028). All the LA myocardial parameters including S-Sr, E-Sr and A-Sr were significantly correlated with E/Em (r = −0.50, −0.528, and −0.360 respectively, all p ≤ 0.015). Similar LA dimension was observed in patients with different degrees of LV diastolic dysfunction while LA myocardial strain rate parameters were all significantly reduced in patients with moderate diastolic dysfunction compared with patients with no diastolic dysfunction (all p < 0.001). Compared with patients of no diastolic dysfunction, the mild diastolic dysfunction group had significantly lower E-Sr (0.76 ±0.34 s− 1 vs 1.17 ± 0.40 s− 1, p < 0.001) but preserved S-Sr and A-Sr. Conclusions: Left atrial myocardial
Abstracts
structured interviews and physical examination. Results: The prevalence of LVH was 52%, significantly higher among women (60% versus 43% p = 0.0033). Systolic blood pressure (SBP) was higher in women with LVH, 154 ± 19 mm Hg, vs. 146± 19 mm Hg in women without LVH, (p < 0.01), and to either group of men, p < 0.0002. In a multivariable logistic regression analysis with gender, diagnosed hypertension, diabetes, and congestive heart failure (CHF) as independent variables, the odds ratio for LVH was doubled for female gender, increased for hypertension, and CHF. An interaction term, between gender and SBP level was significant p = 0.016. The point estimate for female gender was decreased, and hypertension diagnosis is no longer statistically related to LVH, while CHF retains its association. When SBP level is entered into the regression then gender, hypertension, and SBP level, lose significance, which is maintained only for the interaction term, p = 0.037, and CHF, p = 0.047, suggesting that the gender effect on LVH is mediated by the SBP in women. Women with LVH were 3 times more likely than women without LVH and 6.5 times more likely than men with LVH to believe that a BP of 160/100 mm Hg represents their BP goal (p < 0.05). Conclusions: This study demonstrates a high prevalence of LVH in very elderly community dwelling subjects, higher in women and related to SBP. The inadequate understanding of BP goals in this subgroup may contribute to it. doi:10.1016/j.ijcard.2009.09.254
HT000164 Effects of ouabain on hypoxia-induced ANP release in beating rabbit atria L. HONGa, D.Z. DINGb, Y. LANa, X. CUIa,c a Department of Physiology, School of Basic Medical sciences, Yanbian University, China b Cardiovascular Department, Yanbian University Hospital, China c Key Laboratory of Organism Functional Factors of the Changbai Mountain, Ministry of Education, Yanbian University, China Objective: To confirm the effects of hypoxia on the atrial ANP secretion and to determine the relationship between ouabain and hypoxia induced ANP release. Methods: Experiments were performed in a perfused beating rabbit atrial model and thirty New Zealand white rabbits were used. Hypoxic atrial model was produced by Nitrogen gas. While setting up the model, atria were perfused for 60 min and the control period (12 min as an experimental cycle) was followed by different series of experiments simultaneously atrial dynamics were monitored. ANP levels in the atrial perfusates were measured by radioimmunoassay. Results: ① Hypoxia significantly increased atrial ANP secretion and concomitantly decreased atrial pulse pressure and stroke volume compared with control period. ② Ouabain (6.0 μmol/L) as an inhibitor of Na+–K+/ATPase increased atrial ANP secretion significantly. While atrial pulse pressure and stroke volume showed an increased tendency at the beginning when infusing ouabain one cycle, but then a decrease significantly occurred upon two cycles of recovery. ③ With pretreatment of ouabian (6.0 μmol/L), hypoxia still increased atrial ANP, but ouabain obviously attenuated the effects of hypoxia-induced ANP secretion. ④ Atrial histochemistry results showed that ouabain (6.0 μmol/L) induced atrial interstitial edema only. However, hypoxia induced interstitial edema simultaneously with cellular edema in atrial tissue section with or without ouabain. ⑤ In the presence of KB-R7943 (10 μmol/L), an inhibitor of reversed Na+–Ca2+ exchanger, the atrial tissue section showed cellular edema only by ouabain. Conclusions: ① Hypoxia significantly increased atrial ANP secretion in rabbit isolated atrium; ② Ouabain as an inhibitor of Na+–K+/ATPase significantly augmented atrial ANP secretion but attenuated the effects of hypoxia-induced increases of ANP release; ③ Hypoxia regulated
myocytic ANP release was closely related to Na+–K+/ATPase inhibition and atrial stretching. doi:10.1016/j.ijcard.2009.09.255 HT000227 The predictive effects of serum non-high-density lipoprotein cholesterol on the incidence of cardiovascular disease: Results from CMCS followed-up 12 years JIE REN, JING LIU, MIAO WANG, DONG ZHAO The Capital Medical University attached Beijing Anzhen Hospital, Beijing Institute of Heart, Lung & Blood Vessel Diseases, China Objective: To evaluate the predictive effects of serum non-highdensity lipoprotein cholesterol (non-HDL-C) on risk of cardiovascular diseases (CVD) in Chinese population aged 35–64 years. Methods: This prospective study was performed from 1992 to 2004 in 11 provinces of China and the association between baseline non-HDL-C level and the risk of CVD was analyzed in 29,937 subjects aged 35– 64 years using Cox multivariate proportional hazards regression. CVD including acute coronary event (ACE), acute ischemic stroke, hemorrhagic stroke and total CVD events. Results: (1) Adjusted for age, sex, smoking status, diabetes, body index and blood pressure, the relative risk of ACE and CVD in groups of non-HDL-C 130–159, 160– 189 and ≥190 mg/dL was 1.24 (0.91–1.70), 1.78 (1.25–2.53), 2.23 (1.48–3.35) and 1.37 (1.16–1.62), 1.54 (1.26–1.88), 1.60 (1.25–2.04), respectively. Significantly higher than reference group (<130 mg/dL). The risk of ischemic and hemorrhagic strokes was higher in groups 130–159 and 160–189 mg/dL than reference group, RR was 1.34, 1.38 and 1.49, 1.69 respectively, but no difference was found in group≥190 mg/dL. (2) NonHDL-C was responsible to 12.9% of the ACE and 6.5% of the total CVD. (3) When VLDL-C and LDL-C were jointly analyzed, an increased incidence of CAE and CVD was found with the increase of VLDL-C, the relative risk in group of VLDL-C 20–30 mg/dL was the most obvious in all groups. No difference was found in ischemic and hemorrhagic strokes. Conclusion: Non-HDL-C was strongly associated with the incidence of ACE and CVD. VLDL-C plays a critical role in the development of ACE and CVD. The relationship between non-HDL-C and ischemic and hemorrhagic strokes was unclear in Chinese population. doi:10.1016/j.ijcard.2009.09.256 HT000245 Left ventricular diastolic function in hypertensive patients with different geometric patterns of left ventricle BRANISLAVA IVANOVIC, MARIJANA TADIC Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Yugoslavia Objective: The aim of this study was to evaluate diastolic function of left ventricle in hypertensive patients with different geometric patterns of left ventricle. Design and met:h:od: The study included 88 hypertensive patients (mean age 52 ± 8 years) and 45 healthy persons (mean age 51 ±7 years). The endsystolic and enddiastolic left ventricle dimensions, thickness of interventricular septum (IVS) and left ventricle posterior wall (PWT) were measured in all subjects by using two-dimensional echocardiography. The ratio of early and late diastolic transmitral flow velocities (E/A) was assessed by Doppler echocardiography and the ratio of early diastolic mitral flow velocity was achieved by pulsed-wave Doppler and tissue Doppler (E/Ea) in all subjects. Left ventricle mass index (LVMI) was calculated for all subjects. According to the value of relative wall thickness (RWT) and LVMI hypertensive patients were subdivided into four groups: normal (N) 30 (34%), concentric remodeling (CR) 28 (31.8%), concentric
Abstracts
hypertrophy (CH) 20 (22.7%) and eccentric hypertrophy (EH) 10 (11.4%) patients. Results: The E/A ratio gradually decreased in hypertensive patients from N to EH group (N, 1.1 ± 0.13; CR, 1.01 ± 0.14; CH, 0.88 ± 0.15; EH, 0.85 ± 0.14), and it was lower comparing it with control group (1.24 ± 0.19), (p < 0.01 for all). The E/Ea ratio was higher in all hypertensive groups (N, 9.43 ± 1.72; CR, 10.09 ± 2.86; CH, 14.85 ± 3.76; EH, 11.66 ± 3.03) compared with the controls (6.58 ± 1.12), (p < 0.01 for all). In CH group the E/Ea ratio was higher than in N, CR and EH groups (p < 0.01, p < 0.01, p = 0.02, respectively). The E/Ea ratio in hypertensive group was correlated with LVMI (r = 0.29, p < 0.01), RWT (r = 0.21, p = 0.032) and IVS (r = 0.31, p < 0.01). Conclusion: Left ventricular diastolic function is impaired in all hypertensive patients. The degree of geometric pattern diastolic cardiac function damage is the most obvious in concentric hypertrophy left ventricle geometric pattern. doi:10.1016/j.ijcard.2009.09.257 HT000246 The impact of different geometric patterns of left ventricle on myocardial performance index in hypertensive patients BRANISLAVA IVANOVIC, MARIJANA TADIC, DRAGAN SIMIC Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Yugoslavia Objective: The aim of this study was to evaluate global left ventricle function in hypertensive patients with different geometric patterns of left ventricle by using myocardial performance index (MPI). Design and method: The study included 88 hypertensive patients (mean age 52 ± 8 years) and 45 healthy persons (mean age 51 ± 7 years). The endsystolic and enddiastolic left ventricle dimensions, thickness of interventricular septum (IVS) and left ventricle posterior wall (PWT) were measured in all subjects by using two-dimensional echocardiography. The left ventricle mass index (LVMI) was calculated for all. The ratio of early and late diastolic transmitral flow velocities (E/A), the global left ventricular isovolumic relaxation (IVRT) and contraction time (IVCT), and ejection time (ET) were achieved by pulsed-wave Doppler. MPI was calculated by using the formula (IVRT + IVCT) / ET. According to the value of relative wall thickness (RWT) and LVMI hypertensive patients were subdivided into four groups: normal (N) 30(34%), concentric remodeling (CR) 28 (31.8%), concentric hypertrophy (CH) 20(22.7%) and eccentric hypertrophy (EH) 10(11.4%) patients. Results: The E/A ratio gradually decreased in hypertensive patients (N, 1.1 ±0.13; CR, 1.01 ± 0.14; CH, 0.88 ±0.15; EH, 0.85 ± 0.14), and it was lower comparing it with control group (1.24 ±0.19), (p < 0.01 for all). In all hypertensive groups of patients the MPI was higher than in controls (N, 0.54 ±0.05; CR, 0.57 ± 0.06; CH, 0.68± 0.08; EH, 0.58± 0.06 vs. 0.38 ±0.04; p < 0.01 for all hypertensive groups). The MPI was higher in CH group than in N, CR and EH group (p < 0.01 for all). The MPI of hypertensive patients was correlated with LVMI (r = 0.32, p < 0.01), RWT (r = 0.28, p = 0.02) and IVS (r =0.35, p <0.01). Conclusion: The global left ventricle function is impaired in all hypertensive patients according to MPI compared with controls. This damage is the most evident in concentric hypertrophy geometric pattern. doi:10.1016/j.ijcard.2009.09.258 HT000343 Five years prognosis of patients with arterial hypertension and left ventricular hypertrophy DRAGAN DJORDJEVICa, IVAN TASICa, BOJANA STAMENKOVICa, MILAN LOVICa, BRANKO LOVICb, DRAGAN LOVICb a Institute for Treatment and Rehabilitation Niska Banja, Yugoslavia b Inter Medica, Yugoslavia
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Objectives: Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiovascular complications independently of other known risk factors. In practice, it is very important to predict outcome for every patient at the beginning of the treatment. The aim of the study was to examine the correlation between non-invasive parameters at the beginning of the study and bad outcomes in patients with essential arterial hypertension and left ventricular hypertrophy after five years follow-up, using regular antihypertensive therapy. Design and methods: Ninety patients (average age 55 years) with essential hypertension and left ventricular hypertrophy were examined. All patients were studied at baseline, after discontinuation of previous antihypertensive therapy for at least four half-lives. The follow-up period, started at the baseline examination and lasted five years. Adverse cardiovascular events occurred in 15 (16.7%) patients. Results: Noninvasive parameters were tested by stepwise multiple regression analysis. Three examined parameters had predictive value: QTc interval dispersion (beta = .325, p = 0.001), septal wall thickness (beta= .294, p = .003) and low increase of heart rate during exercise testing (beta = −.202, p < .04). For this model adjusted R square = .203; F3,84 = 8.406, p < 0.0001. Conclusions: Patients with greater QTc dispersion, greater septum thickness and lower increase of heart rate during exercise testing have bad five years outcome in spite of regular medical treatment. These patients should be recognized as early as possible and treatment should be more aggressive. doi:10.1016/j.ijcard.2009.09.259
HT000396 Relationship between left atrial deformation and left ventricular diastolic dysfunction in hypertensive patients: A strain rate imaging study ZHIQIANG GUANa, DI ZHANGa, FANG ZHANGb, QINGRON WANGa, RONJIE HUANGc, SHANGYON ZHUa a Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, China b Department of Electrocardiography, The First Affiliated Hospital of Guangxi Medical University, China c Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, China Objectives: The present study was designed to investigate the relationship between left atrial (LA) myocardial function and left ventricular (LV) diastolic dysfunction by strain rate imaging. Design and methods: 48 essential hypertensive patients and 21 age-matched normal controls were included in the study. LV diastolic dysfunction was classified into no, mild, moderate, and severe groups by using conventional echocardiography and tissue Doppler imaging (TDI). Peak strain rate in the systole (S-Sr), early diastole (E-Sr) and late diastole (ASr) was obtained from Doppler derived strain rate imaging to evaluate the LA myocardial deformation. Association between LA myocardial deformation and ratio of mitral peak E velocity to mitral annulus early diastolic velocity (E/Em ratio) was assessed by Pearson correlation coefficient. Results: E-Sr was significantly lower in hypertensive patients than normal controls (0.88 ± 0.35 s− 1 vs 1.04 ± 0.18 s− 1, p = 0.028). All the LA myocardial parameters including S-Sr, E-Sr and A-Sr were significantly correlated with E/Em (r = −0.50, −0.528, and −0.360 respectively, all p ≤ 0.015). Similar LA dimension was observed in patients with different degrees of LV diastolic dysfunction while LA myocardial strain rate parameters were all significantly reduced in patients with moderate diastolic dysfunction compared with patients with no diastolic dysfunction (all p < 0.001). Compared with patients of no diastolic dysfunction, the mild diastolic dysfunction group had significantly lower E-Sr (0.76 ±0.34 s− 1 vs 1.17 ± 0.40 s− 1, p < 0.001) but preserved S-Sr and A-Sr. Conclusions: Left atrial myocardial